Effect Of Preoperative Loading Dose Ticagrelor And Clopidogrel On No-reflow Phenomenon During Intervention In Patients With St-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention:a Systematic Review And Meta-analy

Objective: To systematic evaluate the efficacy and safety of preoperative loading does ticagrelor and clopidogrel about no-reflow phenomenon during intervention in patients with ST-segment elevation myocardial infraction(STEMI)undergoing primary percutaneous coronary intervention(PPCI).Methods: We retrieved from the Cochrane Library,Web of Science,Pub Med,CNKI,CBM,VIP database and Wan Fang database to collected related published studies,including randomized controlled trials(RCTs)and observational studies.The retrieval time is from inception to January 2017.Two researchers assessed the quality of included studies and extracted data and evaluated the bias risk independently.And then meta-analysis was performed by Rev Man 5.3 software.Results: 14 RCTs and 1 non-RCT including 4162 patients were included.In those articles,1521 patients in the ticagrelor group(180 mg)and 2641 patients in the clopidogrel group(600 mg).Meta-analysis results showed that compared with clopidogrel group(1)the preoperative loading does ticagrelor can significantly reduce the incidence of NRF during PPCI(95% CI: 0.15~0.39,P<0.05)and the level of postoperative corrected thrombolysis in myocardial infarction(TIMI)frame count(c TFC)(95% CI:-8.89~-6.91,P<0.05).(2)the preoperative loading does ticagrelor can significantly reduce the incidence of major adverse cardiovascular events(MACE)in hospitalization,including 30 days and 180 days after PPCI(95% CI: 0.41~0.82;95% CI: 0.15~0.46,P<0.05,respectively).(3)The preoperative loading does ticagrelor can significantly improve the TIMI flow after PPCI(95% CI: 1.40~2.45,P<0.05).(4)No significant difference was observed in bleeding events within 30 days and 180 days after PPCI(95%CI:0.71~1.54,P=0.82;95% CI: 0.81~3.19,P=0.18,respectively).Conclusion: Comparing with clopidogrel,patients with STEMI undergoing PPCI using preoperative loading does ticagrelor can effectively reduce the occurrence of no-reflow phenomenon during PPCI and the incidence of near-term MACE.Furthermore,loading does ticagrelor does not increase the risk of bleeding no matter in hospital or within 180 days after PPCI.Due to the limitations of the number and quality of studies included in this article,the above conclusion still needs to be confirmed by more high-quality clinical trials.